Natalizumab is associated with improved relapse outcomes and lower healthcare utilization versus ocrelizumab in treatment-naïve people with multiple sclerosis

Objectives Natalizumab (NTZ) and ocrelizumab (OCR) are well-established therapies and commonly considered first-line for newly diagnosed people with multiple sclerosis (pwMS) in the United States. However, there is a paucity of data comparing healthcare resource utilization (HCRU) and relapse outcomes between NTZ and OCR in this population.Methods This retrospective longitudinal analysis using the Komodo Health Claims Database included newly diagnosed treatment-naïve pwMS aged 18–64 years with ≥1 prescription claims for NTZ or OCR between 1 January 2017 and 31 March 2022. Propensity score matching (1:2) was used to balance baseline characteristics. Outcomes included HCRU and costs, as well as relapses. Relapse events were identified using a claims‑based algorithm.Results The analysis included 1,261 NTZ- and 2,522 OCR-treated pwMS. First-line NTZ treatment was associated with significantly lower annualized rates of all-cause inpatient admissions (rate ratio = 0.61, 95% CI = 0.44–0.85; p = 0.003) and costs as well as emergency department visits (rate ratio = 0.80, 95% CI = 0.68–0.96; p = 0.015) than first-line OCR treatment. Annualized relapse rates (ARR) were significantly lower with first-line NTZ versus OCR treatment (0.20 vs. 0.28; rate ratio = 0.70, 95% CI = 0.59–0.82; p < 0.001). There was also a significantly higher probability of pwMS being relapse-free at 3 years with first-line NTZ versus OCR (69.9% vs. 63.9%; p = 0.002).Limitations This study has limitations inherent to claims data, including limited clinical detail and reliance on a claims-based relapse algorithm.Conclusions This real-world, claims-based analysis demonstrates that first-line NTZ treatment was associated with significantly lower inpatient and emergency department HCRU, inpatient healthcare costs, and ARR than first-line OCR treatment. Given the paucity of comparative data among these therapies in newly diagnosed MS patients, these results provide valuable real-world evidence to help guide treatment decisions in this group.